DSM-5 and Psychiatric note

Question 1

Post-World War II History of DSM

Answer 1

● U.S. Army & the VA develop classification system
● Psychophysiological, personality, & acute
disorders
● 1952 APA Committee on Nomenclature &
Statistics created DSM-I
● 1st official manual focusing on clinical utility
1980: DSM III

Question 2

1994 DSM IV

Answer 2

● 6 year effort involving >1000 individuals and
other professional organizations
● Comprehensive review of literature to
establish firm empirical basis
● Classification changes
● Diagnostic criteria sets
● Descriptive text

Question 3

2013 DSM 5

Answer 3

o Definition of a mental disorders modified
o Multi-axial Assessment Diagnosis eliminated
o Continued emphasis on evidence
o Better assessment of symptom severity
o Handling co-occurring disorders
o Reducing diagnoses previously called “Not Otherwise Specified (NOS)”
o Better specificity of “treatment targets” for clinicians

Question 4

DSM-5: Definition of a Mental Disorder

Answer 4

“A mental disorder is a syndrome characterized by clinically significant
disturbance in an individual’s cognition, emotion regulation [emphasis added],
or behavior that reflects a dysfunction in the psychological, biological, or
developmental processes [emphasis added] underlying mental functioning.

Question 5

DSM-V and Austism

Answer 5

In DSM IV there were separate disorders:

1. Autistic disorder
2. Asperger’s disorder
3. Childhood disintegrative disorder
4. Pervasive developmental disorder,
   NOS

DSM-5 combines all these disorders into a single new disorder called:
“Autism Spectrum Disorder (ASD)”

Question 6

DSM 5 change to ADHD

Answer 6

DSM-5: ADHD
1. Age of onset
○ Symptoms required to begin by age 12 (instead of 7)
2. 5 symptoms required in any subsection (instead of 6)

The revised criteria may result in over-diagnosis of ADHD, with prevalence
rates already ranging 5-15% worldwide

Question 7

Biggest advantages to current DSM

Answer 7

● Consistent Diagnosis:
● Common Language:
● Researching Disease:
● Researching Treatment:

Question 8

Standard Medical Evaluation
versus Psychiatric Evaluation

Answer 8

Standard Medical
● Much more objective
● Several external validating
criteria (blood & imaging tests)
● High diagnostic reliability

Psychiatric
● Much more subjective
● No external validating criteria
(such as blood & imaging tests)
● Lower diagnostic reliability

Question 9

First Part of the two part psychiatric evaluation

Answer 9

● Histories (e.g., psychiatric, medical, family)

Question 10

Second part of two part psychiatric exam

Answer 10

● Mental Status Examination
Systematically reviews:
● Patient’s emotional functioning
● Patient’s cognitive functioning

Question 11

Psychiatric History allows the PA to understand

Answer 11

dives much further into the record of the
patient’s life:
● Who the patient is
● Where the patient has come from
● Where the patient is likely to go in the future
● The patient’s individual personality characteristics
● Insights regarding the nature of patient’s relationships

Question 12

Major area of difference in psychiatric history when compared to standard medical history

Answer 12

Personal History